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Meta-Analysis
. 2024 Jan 1;20(1):66-74.
doi: 10.4244/EIJ-D-22-00809.

Ultrasound guidance for transfemoral access in coronary procedures: an individual participant-level data metaanalysis from the femoral ultrasound trialist collaboration

Marc-André d'Entremont  1   2   3 , Sulaiman Alrashidi  3 , Arnold H Seto  4 , Phong Nguyen  5   6 , Guillaume Marquis-Gravel  7 , Mazen S Abu-Fadel  8 , Craig Juergens  6   9 , Pierre Tessier  10 , Samuel Lemaire-Paquette  2 , Laura Heenan  1 , Elizabeth Skuriat  1 , Jessica Tyrwhitt  1 , Étienne L Couture  2 , Simon Bérubé  2 , Sanjit S Jolly  1   3
Affiliations
Meta-Analysis

Ultrasound guidance for transfemoral access in coronary procedures: an individual participant-level data metaanalysis from the femoral ultrasound trialist collaboration

Marc-André d'Entremont et al. EuroIntervention. .

Abstract

Background: Randomised controlled trials of ultrasound (US)-guided transfemoral access (TFA) for coronary procedures have shown mixed results.

Aims: We aimed to compare US-guided versus non-US-guided TFA from randomised data in an individual participant-level data (IPD) meta-analysis.

Methods: We completed a systematic review and an IPD meta-analysis of all randomised controlled trials comparing US-guided versus non-US-guided TFA for coronary procedures. We performed a one-stage mixed-model meta-analysis using the intention-to-treat population from included trials. The primary outcome was a composite of major vascular complications or major bleeding within 30 days.

Results: A total of 2,441 participants (1,208 US-guided, 1,233 non-US-guided) from 4 randomised clinical trials were included. The mean age was 65.5 years, 27.0% were female, and 34.5% underwent a percutaneous coronary intervention. The incidence of major vascular complications or major bleeding (34/1,208 [2.8%] vs 55/1,233 [4.5%]; odds ratio [OR] 0.61, 95% confidence interval [CI]: 0.39-0.94; p=0.026) was lower in the US-guided TFA group. In the prespecified subgroup of participants who received a vascular closure device, those randomised to US-guided TFA experienced a reduction in the primary outcome (2.1% vs 5.6%; OR 0.36, 95% CI: 0.19-0.69), while no benefit for US guidance was observed in the subgroup without vascular closure devices (4.1% vs 3.3%; OR 1.21, 95% CI: 0.65-2.26; interaction p=0.009).

Conclusions: In participants undergoing coronary procedures by TFA, US guidance decreased the composite outcome of major vascular complications or bleeding and may be especially helpful when using vascular closure devices.

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Conflict of interest statement

A. Seto reports receiving grants or contracts from Arena Medical, Philips, and ACIST; payment or honoraria for speakers’ bureaus from Janssen, Terumo, Getinge, and GE HealthCare; consulting fees from Medtronic and Medicure; and reports having equity in Frond Medical. S. Jolly reports receiving grants or contracts from Boston Scientific; and payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational events from Penumbra. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1. Two-stage fixed-effect and random-effects subgroup meta-analysis for the primary composite outcome by aggregate-level studies (predominantly peripheral vascular disease) and individual participant data studies (exclusively coronary).
CI: confidence interval; OR: odds ratio
Figure 2
Figure 2. Subgroup analysis for the primary composite outcome.
BMI: body mass index; CI: confidence interval; PCI: percutaneous coronary intervention; US: ultrasound
See this image and copyright information in PMC

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